March 2017 - The Opioid Crisis

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Year: 2017
Format: PDF
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Language: English
Publication Date: March 3, 2017
Product Code: AFPj_Volume_7_Issue_1
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March 2017 - The Opioid Crisis

The theme of the first issue of 2017 is “The Opioid Crisis” and the Special Guest Editor is Dr. Tom Gilson. I believe that “crisis” is an appropriate description of the opioid problem facing the nation. Prescription drug abuse and toxicity have skyrocketed in recent years, especially with the emergence of fentanyl and fentanyl analogs and their introduction into clandestinely produced opioids, including both heroin and other “counterfeit” prescription opioids.

This crisis, along with the profoundly increased numbers of opioid-related deaths, has affected medicolegal death investigation systems in an unprecedented manner. Offices are becoming overwhelmed with keeping up with the increased numbers of drug-related deaths to the point that they are needing to hire more death investigators and forensic pathologists. Some offices, however, are not sufficiently supported or funded, and thus, the crisis creates a threat to accreditation as well. 

We begin with a pair of articles. The first discusses the need to autopsy all drug-related deaths in order to best serve the public. The second, while acknowledging the desire to function in this way, presents a temporary solution for those who cannot autopsy every potential drug-related death at this time. The next two papers are reviews on the mechanisms of opioid toxicity and of the emerging family of fentanyl analogs. We then feature a paper discussing the evolution of the opioid crisis in one particular jurisdiction. There is also a paper discussing the medicolegal death investigation of potential drug-related deaths. We have a paper describing the public sharing of information involving the medical examiner and another discussing the benefits of prescription drug monitoring programs for medical examiners. There is also a paper discussing particular challenges for coroner systems in the opioid epidemic. Finally, we feature a paper discussing the role of the Burrage decision in criminal proceedings. We also feature several original articles, two of which address issues relevant to the opioid crisis, and two “Case of the Month” papers.

 

 

ACADEMIC FORENSIC PATHOLOGY:

The Official Publication of the National Association of Medical Examiners

 

March 2017 • Volume Seven • Issue One • The Opioid Crisis

 

EDITORIALS

 

Letter from the Editor-In-Chief..............................................................................................................................vi

J. Keith Pinckard

 

Letter from the NAME President...........................................................................................................viii

Brian L. Peterson

 

Letter from the Guest Editor................................................................................................................................x

Thomas P. Gilson

 

 

INVITED REVIEWS

Drug Intoxication and the Need to Autopsy: A Diagnosis of Exclusion?........................................................................2

David R. Fowler

 

Confronting an Upsurge in Opiate Deaths With Limited Resources..............................................................................7

Thomas A. Andrew, Jennie V. Duval

 

Opioid Toxicity......19

David Dolinak

 

Emerging Synthetic Fentanyl Analogs......36

Harold E. Schueler

 

The Evolution of the Opiate/Opioid Crisis in Cuyahoga County......41

Thomas P. Gilson, Hugh Shannon, Jaime Freiburger

 

Opioid Drug Death Investigations....50

Daniel Morgan

 

Drug Overdose Surveillance and Information Sharing Via a Public Database: The Role of the Medical Examiner/Coroner...60

Karl E. Williams, Michael D. Freeman

 

The Utility of a Prescription Monitoring Program in Death Investigation: The Virginia Experience...73

Amy M. Tharp-Myers, Kathrin Hobron, Ralph Orr

 

County Coroners and Their Role in the Heart of the Opioid Epidemic....80

Renee Robinson

 

Rules for Establishing Causation in Opiate/Opioid Overdose Prosecutions — The Burrage Decision...87

Thomas P. Gilson, Carole Rendon, Joseph Pinjuh

 

ORIGINAL ARTICLES

Common Findings and Predictive Measures of Opioid Overdoses....91

Danielle E. Pelletier, Thomas A. Andrew

 

Gabapentin in Mixed Drug Fatalities: Does This Frequent Analyte Deserve More Attention?...99

Grant Finlayson, Michael Chavarria, Stephanie Chang, Tyler Gardner, Abigail Grande, Colleen MacCallum,
Joyce L. deJong, Kelly Quesnelle

 

Primary Cardiac Tumors in Infancy: A Case Report and Literature Review....112

Carolina Dominguez, Ashley Perkins, Alexandra Duque, Viagnney Bravo

 

Blastomycosis in Wisconsin: Beyond the Outbreaks....119

Katrina Thompson, Alana K. Sterkel, Erin G. Brooks

 

CASE OF THE MONTH

Fatal Rotavirus Infection in a 4-Year-Old with Unsuspected Autoimmune Adrenal Insufficiency....130

Alison Krywanczyk, Elizabeth A. Bundock

A Case of Previously Unsuspected Huntington Disease Diagnosed at Autopsy....136

Catherine R. Miller, Nobby C. Mambo, Jianli Dong, Gerald A. Campbell

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